Health Organization for Pudendal Education

Does anybody out there have erectile dysfunction? I'm a 28 year old male and have had PN/PNE for a few years now. In the last year or so it seems to be harder to get an erection. My dysfunction is that it doesn't get as hard. In fact, it's quite flimsy most of the time now. I don't have any problems ejaculating. I did start taking lyrica which I think probably doesn't help the situation. The Lyrica helps the itching (and maybe helps the pain a little) but maybe it desensitizes my genital area? I feel pretty number around this area anyway so I'm sure something is going on. I think it's probably nerve damage and it's less sensitive.

Does anybody know of anything that helps? Ultimately I'd like to have surgery but in the meantime what has worked for you? It's very frustrating for me (and my gf!) when I'm turned on but can't maintain a proper erection.

Thanks for any and all advice!

Matt

try viagra

Erectile dysfunction is a side effect of Lyrica (and many other drugs used to treat pain). You can ask whoever prescribed the drug for suggestions on dealing with the ED. Viagra might help but I'd check with your doc to make sure there's no drug interaction.

Here is a publication abstract from Shafik. The treatment was on only 7 patients though and I don't know if similar results have been replicated. So I'm not suggesting rushing into surgery but it appears ED can be caused by pudendal neuropathy.

http://www.ncbi.nlm.nih.gov/pubmed/8166577

Arch Androl. 1994 Mar-Apr;32(2):141-9.
Pudendal canal decompression in the treatment of erectile dysfunction.
Shafik A.
Source

Department of Surgery & Research, Faculty of Medicine, Cairo University, Egypt.
Abstract

The results of the treatment of 7 patients with neurogenic erectile dysfunction (ED) by pudendal canal decompression are presented. Ages ranged from 46 to 56 years. Patients had penile, perineal, and scrotal hypoesthesia or anesthesia. EMG of the external urethral sphincter and levator ani muscle revealed diminished activity. There were increased bulbocavernosus and pudendal nerve terminal motor (PNTML) latencies. Patients tested normal for endocrine assays, Doppler examination of the penile arteries penobrachial pressure index, and cavernosometry. Nocturnal penile tumescence activity was absent. These findings pointed to neurogenic ED due to pudendal canal syndrome (PCS). Pudendal canal decompression was done through a para-anal incision. The inferior rectal nerve was followed to the pudendal nerve in the pudendal canal, which was slit open. Mean followup was 19.6 months. No complications were encountered. ED improved in 6 of the 7 patients 2-6 months postoperatively. Sensory and motor changes also improved. It is suggested that chronic straining at stool in these patients led to levator subluxation and sagging, and to pulling on the pudendal nerve with a resulting entrapment in the pudendal canal, pudendal neuropathy, and PCS. ED results from involvement of the penile and perineal branches of the pudendal nerve. To conclude, PCS may cause ED, which improves with pudendal canal decompression.

PMID:
8166577
[PubMed - indexed for MEDLINE]

Here's another article by Shafik:

http://www.ncbi.nlm.nih.gov/pubmed/7786092

Arch Androl. 1995 Mar-Apr;34(2):83-94.
Pudendal artery syndrome with erectile dysfunction: treatment by pudendal canal decompression.
Shafik A.
Source

Department of Surgery and Research, Faculty of Medicine, Cairo University, Egypt.
Abstract

Pudendal artery syndrome (PAS) was studied in 10 patients with erectile dysfunction (ED). Ages ranged from 38 to 55 years. All had chronic constipation and straining at stool, absent nocturnal penile tumescence, low penobrachial pressure index (p < .01), low peak flow velocity (p < .001), and a diameter increase (p < .0001) upon duplex ultrasonography screening. Four of the 10 patients had perineal hypoesthesia, prolonged bulbocavernosus reflex (p < .05), and pudendal nerve terminal motor latency (p < .05), and weak anal reflex and EMG activity of the external anal sphincter. The levator EMG activity was reduced in all patients. Intracavernous papaverine injection induced partial erection after a period longer than normal. Selective pudendal arteriography showed narrowing or obstruction of the distal part of the internal pudendal artery (IPA) on both sides with poorly or non-visualized penile arteries. A generalized arterial disease was excluded and pudendal artery compression in the pudendal canal (PC) was suspected as causing ED. The narrow or obstructed part of the IPA corresponds to the part in the PC. Four of the 10 patients had manifestations of pudendal neuropathy in addition to IPA compression. Pudendal canal decompression (PCD) was performed through a perineal approach. ED improved in 8 of the 10 patients 3-6 months postoperatively. Two of the 4 patients who had pudendal arteriopathy combined with neuropathy did not improve. In conclusion, the 10 patients with ED had common clinical and investigative findings that constitute the pudendal artery syndrome. PCD effected improvement in 80% of the cases.

PMID:
7786092
[PubMed - indexed for MEDLINE]

Thanks Violet! Really appreciate this info. I think it's probably a little bit of both - PN & Lyrica. I'm not sure if something like Viagra would help because I think it's more the sensation and the nerve. Wonder if those type of meds help sensation. I think they might just help blood flow..

Thanks for help you guys/gals.

Matt

Hi Matt

It certainly sounds like diminished nerve function, causing a loss of sensation and motor functions. Lyrica would not cause increased numbness, as far as I know. Ongoing nerve entrapment/irritation causes this gradual diminishment in the nerve function, resulting in what you are experiencing. I am experiencing the same, and like you have said, fixing the erection (blood flow) is only half the problem. Sensation of the penis is just as important, otherwise sex is just impossible.
Fixing the cause of your ongoing entrapment/irritation is the only answer.

Regards

Nathan